Unique Toilet Training Program Helps Youngsters ‘Go’

Every parent knows just how difficult it can be to potty train a child. For some, it’s a seamless process, but for many, it’s a pro- longed challenge.

Thanks to a comprehensive program at NYU Winthrop Hospital , led by Fredric Daum, MD, Chief of Pediatric Gastroenter- ology, Hepatology and Nutrition at NYU Winthrop, and Medical Director of NYU Winthrop’s Pediatric Bowel Management Program, parents of children who are experiencing delays in toilet training can find support and a solution to achieving what is a very important milestone for every child.

Stacey Cupolo of Massapequa Park knew toilet training challenges quite well. As the mother of a now 9-year-old son, Scott, who has Attention Deficit Hyperactivity Disorder (ADHD), Mrs. Cupolo grew increasingly frustrated as Scott remained dependent on pull ups to get through episodes of bed-wetting, stool withholding, and encopresis (fecal soling in children ages four and older) over the years.

“I didn’t want him to be embarrassed at school and we needed to do something,” she said. So when one of Scott’s physicians recommended they seek a medical consultation with Dr. Daum, Mrs. Cupolo did not delay.

Dr. Daum has over 45 years of experience in pediatric gastroenterology, treating pediatric patients with various forms of fecal inconti- nence, including stool withholding and encopresis. As director of the “All About the Toilet” program, which he began at NYU Winthrop in 2006, Dr. Daum provides medical consul- tations for families with children of all ages – including those with special needs such as autism, Attention Deficit Disorder (ADD), ADHD and chromosomal abnormalities.

“I understand what’s going on in the home, and the effects that encopresis can have on the family and the child because I have been there,” said Dr. Daum.

The Age-Old Question

The age-old question as to when a child should be toilet trained has always been controversial, according to Dr. Daum.

“It is generally agreed that children without special needs, who are capable emotionally and physically, can be trained by the age of three,” said Dr. Daum. “Children with special needs may take longer and may be able to achieve only certain aspects of toilet training. I see new patients as young as three, and as old as 16. I try not to turn anyone away.”

For many children, delays in toilet training stem from having had a painful bowel movement, which leads to the child withholding (a behavior used to exert and maintain control over bowel movements) and encopresis. Dr. Daum discusses this pattern in great depth with parents and other caregivers during a two-hour educa- tional seminar, “All about the Toilet.” Seminars are held on Thursday mornings throughout the year at NYU Winthrop (see below for upcoming dates and additional information).

A post-seminar appointment with Dr. Daum is recommended. If the child is diag- nosed with encopresis secondary to stool withholding, parents are encouraged to take the next step in the program, which combines the use of oral laxatives and behavioral modi- fication. This approach has proven effective in helping children respond to the urge to “go” and ultimately self initiation.

“Stopping encopresis is the major goal of this program,” said Dr. Daum. “The key to success is having the full support of the child’s caregivers, including parents, grand- parents and babysitters. Everyone has to be on board.”

Getting Down to Business: The Program in a Nutshell

During the first 24 hours of the program, the child (wearing underwear) receives senna (an oral medication used to treat constipa- tion and empty the large intestine). He/she spends most of this time in the bathroom, which has been transformed into a “party room.” It is here that the child, surrounded by his/her toys and favorite personal items, begins to understand the urge to “go,” with many children actually self-initiating on the very first day. At night, the child sleeps in his/her own bed.

On day two of the program, children gradually move out of the “party room” and “earn more space in the room adjacent to the party room.” Self-initiation continues and the child no longer soils stool. Timing of the senna dosage also changes, enabling families to better predict when bowel movements will occur. The goal usually is for the child to use the toilet at home after school activities.

“Children can be toilet trained in about a week – making the transition back to school and camp and other activities much less stressful,” said Dr. Daum.

Committed to Success
for Every Child

Dr. Daum is committed to seeing every single one of his patients succeed. Return visits and regular telephone consultations continue until the child’s toilet training issues are fully resolved. In fact, Dr. Daum shares his personal cell phone with each parent who enrolls in the program, speaking with them every evening until the child is self-initiating and clean. This attentiveness means a lot to parents like Mrs. Cupolo, who vividly remembers one telephone call she had with him while her son was just starting the program.

“Dr. Daum was at a hockey game with his son yet he took the time to walk me through what I needed to do for my child,” said Mrs. Cupolo. “That’s pretty amazing.”

To date, Dr. Daum has helped hundreds of children achieve toilet training success at NYU Winthrop and he encourages parents of children who are struggling to seek help.

“Parents should not feel as though they have failed,” he said. “They have my full support and I am committed to getting each family through what can often be a difficult experience.”

Dr. Daum did just that for the Cupolo family, who were finally able to able to overcome the toilet training challenges they once faced.

“I know firsthand just how frustrating this can be – both for the child and the par- ent,” said Mrs. Cupolo. “My only regret is not starting our son in this program years ago.”